An audit of induction of anaesthesia in neonates and small infants using pulse oximetry

Abstract

The frequency and severity of hypoxaemia during induction of anaesthesia in neonates and small infants at the Norfolk and Norwich Hospital, a district general hospital, was compared, using pulse oximetry, with that of the nearest specialist hospital, the Queen Elizabeth Hospital for Sick Children in London. There were differences in stafing and the choice of anaesthetic techniques between the hospitals. One third of the patients in both hospitals experienced desaturation of more than 5% (moderate or severe hypoxaemia) at one or more recordings during induction. The highest incidence of hypoxaemia was associated with awake intubation. There was no statistical diyerence in the incidence or severity of hypoxaemia between the hospitals. In the district general hospital, moderate or severe hypoxaemia of greater than 30 s duration was more likely if an anaesthetist with a regular paediatric operating list was not present at induction ( p < 0.01).

Use of methohexital for elective intubation in neonates

“…Similar studies carried out on stable patients, like an anaesthetic induction prior to minor surgery, also describe oxygen saturation drops during intubation. In two different hospitals Kong et al 30 found that 30% of the neonates and small infants experienced desaturation of more than 5% at one or more recordings during induction. Lackcock and McNicol31found that about 40% of the children who where aged under one year suffered a maximum fall to less than 90% saturation during induction of anaesthesia.…”

Should we reconsider awake neonatal intubation? A review of the evidence and treatment strategies

“…Awake intubation is associated with more severe and prolonged hypoxia than when anaesthesia is employed (26,28). Premedication with pethidine is not sufficient to avoid hypoxia, but anaesthesia and paralysis have been shown to speed up the time taken to successful intubation, which reduces the severity and duration of hypoxia (23,29).…”

Premedication for Nonemergent Neonatal Intubations: A Randomized, Controlled Trial Comparing Atropine and Fentanyl to Atropine, Fentanyl, and Mivacurium

“…[18][19][20][21][22] Reasons why this practice has not been widely adopted may include lack of familiarity with the medications, fear of adverse effects, insufficient evidence for efficacy and safety, or lack of consensus regarding optimal combination of medications. It is also difficult to apply previous study results to current practice because many of the medications studied, such as thiopental, 6,11,15 pethidine, 7 or anesthetic agents, 9,12 are not commonly used in the NICU. In addition, succinylcholine, one of the more frequently studied muscle relaxants, is no longer recommended for routine use in children.…”

“…In addition to causing discomfort, placing an endotracheal tube (ETT) without premedication is associated with adverse physiologic effects. These effects include bradycardia, 2,3 fluctuations in blood pressure (BP), [2][3][4][5][6][7][8] hypoxia, 2,3,7,[9][10][11] and increases in intracranial pressure (ICP). 3,4,6,8,12,13 Previous studies have shown that these potentially adverse effects can be attenuated by using pharmacologic agents.…”